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132nd MAINE LEGISLATURE
FIRST REGULAR SESSION-2025
Legislative Document No. 743
H.P. 485 House of Representatives, February 25, 2025
An Act to Increase the Availability and Affordability of Health Care
by Eliminating Certificate of Need Requirements
Reference to the Committee on Health Coverage, Insurance and Financial Services
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative LIBBY of Auburn.
Cosponsored by Senator HAGGAN of Penobscot and
Representatives: BOYER of Poland, FOLEY of Wells, NUTTING of Oakland.
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1Be it enacted by the People of the State of Maine as follows:
2Sec. 1. 22 MRSA c. 103-A, as amended, is repealed.
3Sec. 2. 22 MRSA §1708, sub-§3, ¶D, as amended by PL 2013, c. 594, §1, is further
4 amended to read:
5 D. Ensure that any calculation of an occupancy percentage or other basis for adjusting
6 the rate of reimbursement for nursing facility services to reduce the amount paid in
7 response to a decrease in the number of residents in the facility or the percentage of the
8 facility's occupied beds excludes all beds that the facility has removed from service for
9 all or part of the relevant fiscal period in accordance with section 333. If the excluded
10 beds are converted to residential care beds or another program for which the department
11 provides reimbursement, nothing in this paragraph precludes the department from
12 including those beds for purposes of any occupancy standard applicable to the
13 residential care or other program pursuant to duly adopted rules of the department;
14Sec. 3. 22 MRSA §1714-A, sub-§4, ¶C, as amended by PL 2011, c. 687, §8, is
15 further amended to read:
16 C. The department shall provide in a letter written notice of the requirements of this
17 section to the transferee in a letter acknowledging receipt of a request for a certificate
18 of need or waiver of the certificate of need for the case of a nursing home or hospital
19 transfer or in response to a request for an application for a license to operate a boarding
20 home or to provide other health care services.
21Sec. 4. 22 MRSA §1715, sub-§1, ¶A, as amended by PL 2017, c. 475, Pt. A, §29,
22 is further amended to read:
23 A. Is either a direct provider of major ambulatory service, as defined in former section
24 382, subsection 8‑A, or is or has been required to obtain a certificate of need under
25 section 329 or former section 304 or 304-A;
26Sec. 5. 22 MRSA §1831, sub-§1, as amended by PL 2013, c. 214, §1, is further
27 amended to read:
281. Provision of information. In order to provide for informed patient or resident
29 decisions, a hospital or nursing facility shall provide a standardized list of licensed
30 providers of care and services and available physicians for all patients or residents prior to
31 discharge for whom home health care, hospice care, acute rehabilitation care, a hospital
32 swing bed as defined in section 328, subsection 15 or nursing care is needed. The list must
33 include a clear and conspicuous notice of the rights of the patient or resident regarding
34 choice of providers.
35 A. For all patients or residents requiring home health care or hospice care, the list must
36 include all licensed home health care and hospice providers that request to be listed
37 and any branch offices, including addresses and phone numbers, that serve the area in
38 which the patient or resident resides.
39 B. For all patients or residents requiring nursing facility care or a hospital swing bed,
40 the list must include all appropriate facilities that request to be listed that serve the area
41 in which the patient or resident resides or wishes to reside and the physicians available
42 within those facilities that request to be listed.
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1 C. The hospital or nursing facility shall disclose to the patient or resident any direct or
2 indirect financial interest the hospital or nursing facility has in the nursing facility or
3 home health care provider.
4Sec. 6. 22 MRSA §2061, sub-§2, as amended by PL 2011, c. 90, Pt. J, §19, is
5 further amended to read:
62. Review. Each project for a health care facility has been reviewed and approved to
7 the extent required by the agency of the State that serves as the designated planning agency
8 of the State or by the Department of Health and Human Services in accordance with the
9 provisions of the Maine Certificate of Need Act of 2002, as amended;
10Sec. 7. 24-A MRSA §4203, sub-§1, as amended by PL 2003, c. 510, Pt. A, §19, is
11 further amended to read:
121. Subject to the Maine Certificate of Need Act of 2002, a A person may apply to the
13 superintendent for and obtain a certificate of authority to establish, maintain, own, merge
14 with, organize or operate a health maintenance organization in compliance with this
15 chapter. A person may not establish, maintain, own, merge with, organize or operate a
16 health maintenance organization in this State either directly as a division or a line of
17 business or indirectly through a subsidiary or affiliate, nor sell or offer to sell, or solicit
18 offers to purchase or receive advance or periodic consideration in conjunction with, a health
19 maintenance organization without obtaining a certificate of authority under this chapter.
20Sec. 8. 24-A MRSA §4204, sub-§1, as corrected by RR 2021, c. 1, Pt. B, §342, is
21 repealed.
22Sec. 9. 24-A MRSA §4204, sub-§2-A, as amended by PL 2013, c. 588, Pt. A, §29,
23 is further amended to read:
242-A. The superintendent shall issue or deny a certificate of authority to any person
25 filing an application pursuant to section 4203 within 50 business days of receipt of the
26 notice from the Department of Health and Human Services that the applicant has been
27 granted a certificate of need or, if a certificate of need is not required, within 50 business
28 days of receipt of notice from the Department of Health and Human Services that the
29 applicant is in compliance with the requirements of paragraph B. Issuance of a certificate
30 of authority shall must be granted upon payment of the application fee prescribed in section
31 4220 if the superintendent is satisfied that the following conditions are met. :
32 A. The Commissioner of Health and Human Services certifies that the health
33 maintenance organization has received a certificate of need or that a certificate of need
34 is not required pursuant to Title 22, chapter 103‑A.
35 B. If the The Commissioner of Health and Human Services has determined that a
36 certificate of need is not required, the commissioner makes a determination and
37 provides a certification to the superintendent that the following requirements have been
38 met. :
39 (4) The health maintenance organization must establish and maintain procedures
40 to ensure that the health care services provided to enrollees are rendered under
41 reasonable standards of quality of care consistent with prevailing professionally
42 recognized standards of medical practice. These procedures must include
43 mechanisms to ensure availability, accessibility and continuity of care. ;
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1 (5) The health maintenance organization must have an ongoing internal quality
2 assurance program to monitor and evaluate its health care services including
3 primary and specialist physician services, ancillary and preventive health care
4 services across all institutional and noninstitutional settings. The program must
5 include, at a minimum, the following:
6 (a) A written statement of goals and objectives that emphasizes improved
7 health outcomes in evaluating the quality of care rendered to enrollees;
8 (b) A written quality assurance plan that describes the following:
9 (i) The health maintenance organization's scope and purpose in quality
10 assurance;
11 (ii) The organizational structure responsible for quality assurance
12 activities;
13 (iii) Contractual arrangements, in appropriate instances, for delegation of
14 quality assurance activities;
15 (iv) Confidentiality policies and procedures;
16 (v) A system of ongoing evaluation activities;
17 (vi) A system of focused evaluation activities;
18 (vii) A system for reviewing and evaluating provider credentials for
19 acceptance and performing peer review activities; and
20 (viii) Duties and responsibilities of the designated physician supervising
21 the quality assurance activities;
22 (c) A written statement describing the system of ongoing quality assurance
23 activities including:
24 (i) Problem assessment, identification, selection and study;
25 (ii) Corrective action, monitoring evaluation and reassessment; and
26 (iii) Interpretation and analysis of patterns of care rendered to individual
27 patients by individual providers;
28 (d) A written statement describing the system of focused quality assurance
29 activities based on representative samples of the enrolled population that
30 identifies the method of topic selection, study, data collection, analysis,
31 interpretation and report format; and
32 (e) Written plans for taking appropriate corrective action whenever, as
33 determined by the quality assurance program, inappropriate or substandard
34 services have been provided or services that should have been furnished have
35 not been provided. ;
36 (6) The health maintenance organization shall must record proceedings of formal
37 quality assurance program activities and maintain documentation in a confidential
38 manner. Quality assurance program minutes must be available to the
39 Commissioner of Health and Human Services. ;
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1 (7) The health maintenance organization shall must ensure the use and
2 maintenance of an adequate patient record system that facilitates documentation
3 and retrieval of clinical information to permit evaluation by the health maintenance
4 organization of the continuity and coordination of patient care and the assessment
5 of the quality of health and medical care provided to enrollees. ;
6 (8) Enrollee clinical records must be available to the Commissioner of Health and
7 Human Services or an authorized designee for examination and review to ascertain
8 compliance with this section, or as considered necessary by the Commissioner of
9 Health and Human Services. ; and
10 (9) The health maintenance organization must establish a mechanism for periodic
11 reporting of quality assurance program activities to the governing body, providers
12 and appropriate health maintenance organization staff.
13 The Commissioner of Health and Human Services shall make the certification required
14 by this paragraph within 60 days of the date of the written decision that a certificate of
15 need was not required. If the commissioner Commissioner of Health and Human
16 Services certifies that the health maintenance organization does not meet all of the
17 requirements of this paragraph, the commissioner shall specify in what respects the
18 health maintenance organization is deficient. ;
19 C. The health maintenance organization conforms to the definition under section
204202‑A, subsection 10. ;
21 D. The health maintenance organization is financially responsible, complies with the
22 minimum surplus requirements of section 4204‑A and, among other factors, can
23 reasonably be expected to meet its obligations to enrollees and prospective enrollees.
24 (1) In a determination of minimum surplus requirements, the following terms have
25 the following meanings.
26 (a) "Admitted assets" means assets recognized by the superintendent pursuant
27 to section 901‑A. For purposes of this chapter, the asset value is that contained
28 in the annual statement of the corporation as of December 31st of the year
29 preceding the making of the investment or contained in any audited financial
30 report, as defined in section 221‑A, of more current origin.
31 (b) "Reserves" means those reserves held by corporations subject to this
32 chapter for the protection of subscribers. For purposes of this chapter, the
33 reserve value is that contained in the annual statement of the corporation as of
34 December 31st of the preceding year or any audited financial report, as defined
35 in section 221‑A, of more current origin.
36 (2) In making the determination whether the health maintenance organization is
37 financially responsible, the superintendent may also consider:
38 (a) The financial soundness of the health maintenance organization's
39 arrangements for health care services and the schedule of charges used;
40 (b) The adequacy of working capital;
41 (c) Any agreement with an insurer, a nonprofit hospital or medical service
42 corporation, a government or any other organization for insuring or providing
43 the payment of the cost of health care services or the provision for automatic
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44 applicability of an alternative coverage in the event of discontinuance of the
45 plan;
3 (d) Any agreement with providers for the provision of health care services that
4 contains a covenant consistent with subsection 6; and
5 (e) Any arrangements for insurance coverage or an adequate plan for self-
6 insurance to respond to claims for injuries arising out of the furnishing of
7 health care services. ;
8 E. The enrollees are afforded an opportunity to participate in matters of policy and
9 operation pursuant to section 4206. ;
10 F. Nothing in the proposed method of operation, as shown by the information
11 submitted pursuant to section 4203 or by independent investigation, is contrary to the
12 public interest. ;
13 G. Any director, officer, employee or partner of a health maintenance organization
14 who receives, collects, disburses or invests funds in connection with the activities of
15 that organization shall be is responsible for those funds in a fiduciary relationship to
16 the organization. ;
17 H. The health maintenance organization shall maintain maintains in force a fidelity
18 bond or fidelity insurance on those employees and officers of the health maintenance
19 organization who have duties as described in paragraph G, in an amount not less than
20 $250,000 for each health maintenance organization or a maximum of $5,000,000 in
21 aggregate maintained on behalf of health maintenance organizations owned by a
22 common parent corporation, or such sum as may be prescribed by the superintendent. ;
23 I. If any agreement, as set forth in paragraph D, subparagraph (2), division (c), is made
24 by the health maintenance organization, the entity executing the agreement with the
25 health maintenance organization must demonstrate demonstrates to the
26 superintendent's satisfaction that the entity has sufficient unencumbered surplus funds
27 to cover the assured payments under the agreement, otherwise the superintendent shall
28 disallow may not allow the agreement. In considering approval of such an agreement,
29 the superintendent shall consider the entity's record of earnings for the most recent 3
30 years, the risk characteristics of its investments and whether its investments and other
31 assets are reasonably liquid and available to make payments for health care services .;
32 K. The health maintenance organization provides a spectrum of providers and services
33 that meet patient demand. ;
34 L. The health maintenance organization meets the requirements of section 4303,
35 subsection 1. ;
36 M. The health maintenance organization demonstrates a plan for providing services
37 for rural and underserved populations and for developing relationships with essential
38 community providers within the area of the proposed certificate. The health
39 maintenance organization must make an annual report to the superintendent regarding
40 the plan. ; and
41 O. Each The health maintenance organization shall provide provides basic health care
42 services.
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2
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1 The applicant shall furnish, upon request of the superintendent, any information necessary
2 to make any determination required pursuant to this subsection.
3Sec. 10. 24-A MRSA §4225, as corrected by RR 2021, c. 2, Pt. A, §79, is amended
4 to read:
5§4225. Commissioner of Health and Human Services' authority to contract
6 The Commissioner of Health and Human Services, in carrying out the commissioner's
7 obligations under section 4204, subsection 1, paragraph B; section 4215; and section 4216,
8 subsection 1, may contract with qualified persons to make recommendations concerning
9 the determinations required to be made by the commissioner. Such recommendations may
10 be accepted in full or in part by the commissioner.
11Sec. 11. 24-A MRSA §4303-F, sub-§1, ¶E, as amended by PL 2023, c. 591, §3,
12 is further amended to read:
13 E. A carrier may not require a ground ambulance service provider to obtain prior
14 authorization before transporting an enrollee to a hospital, between hospitals or from a
15 hospital to a nursing home, hospice care facility or other health care facility, as defined
16 in Title 22, section 328, subsection 8. A carrier may not require an air ambulance
17 service provider to obtain prior authorization before transporting an enrollee to a
18 hospital or between hospitals for urgent care. For the purposes of this paragraph, the
19 following terms have the following meanings.
20 (1) "Ambulatory surgical facility" means a facility, not part of a hospital, that
21 provides surgical treatment to patients not requiring hospitalization. "Ambulatory
22 surgical facility" does not include the offices of private physicians or dentists,
23 whether in individual or group practice.
24 (2) "Health care facility" means a hospital, psychiatric hospital, nursing facility,
25 kidney disease treatment center including a freestanding hemodialysis facility,
26 rehabilitation facility, ambulatory surgical facility, independent radiological
27 service center, independent cardiac catheterization center or cancer treatment
28 center. "Health care facility" does not include the office of a private health care
29 practitioner, as defined in Title 24, section 2502, subsection 1‑A, whether in
30 individual or group practice. In an ambulatory surgical facility that functions also
31 as the office of a health care practitioner, the following portions of the ambulatory
32 surgical facility are considered to be a health care facility:
33 (a) Operating rooms;
34 (b) Recovery rooms;
35 (c) Waiting areas for ambulatory surgical facility patients;
36 (d) Any space with major medical equipment; and
37 (e) Any other space used primarily to support the activities of the ambulatory
38 surgical facility.
39 (3) "Health services" means clinically related services that are diagnostic,
40 treatment, rehabilitative services or nursing services provided by a nursing facility.
41 "Health services" includes alcohol or drug dependence, substance use disorder and
42 mental health services.
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1 (4) "Hospital" means an institution that primarily provides to inpatients, by or
2 under the supervision of physicians, diagnostic services and therapeutic services
3 for medical diagnosis, treatment and care of persons who are injured, disabled or
4 sick or rehabilitation services for the rehabilitation of persons who are injured,
5 disabled or sick. "Hospital" also includes psychiatric and tuberculosis hospitals.
6 (5) "Major medical equipment" means a single unit of medical equipment or a
7 single system of components with related functions used to provide medical and
8 other health services that costs $3,200,000 or more. "Major medical equipment"
9 does not include medical equipment acquired by or on behalf of a clinical
10 laboratory to provide clinical laboratory services if the clinical laboratory is
11 independent of a physician's office and a hospital and has been determined to meet
12 the requirements of the United States Social Security Act, Title XVIII, Section
13 1861(s)(10 and 11). In determining whether medical equipment costs more than
14 the threshold provided in this subparagraph, the cost of studies, surveys, designs,
15 plans, working drawings, specifications and other activities essential to acquiring
16 the equipment must be included. If the equipment is acquired for less than fair
17 market value, the cost includes the fair market value. The threshold amount for
18 review must be updated by the commissioner to reflect the change in the Consumer
19 Price Index for medical care services as reported by the United States Department
20 of Labor, Bureau of Labor Statistics, with an effective date of January 1st each
21 year.
22 (6) "Nursing facility" means any facility defined under section 1812‑A.
23 (7) "Rehabilitation facility" means an inpatient facility that is operated for the
24 primary purpose of assisting in the rehabilitation of persons who are disabled
25 through an integrated program of medical services and other services that are
26 provided under competent professional supervision.
27Sec. 12. 24-A MRSA §6203, sub-§1, ¶A, as amended by PL 2003, c. 510, Pt. A,
28 §22, is further amended to read:
29 A. The provider has submitted to the department an application for a certificate of
30 need, if required under Title 22, section 329, and the department has submitted a
31 preliminary report of a recommendation for approval of a certificate of need and the
32 provider has applied for any other licenses or permits required prior to operation.
33Sec. 13. 24-A MRSA §6203, sub-§1, ¶G, as enacted by PL 1995, c. 452, §11, is
34 amended to read:
35 G. The department has approved the adequacy of all services proposed under the
36 continuing care agreement not otherwise reviewed under the certificate of need
37 process.
38Sec. 14. 24-A MRSA §6203, sub-§2, as amended by PL 1995, c. 452, §§12 to 16,
39 is further amended to read:
402. Final certificate of authority. The superintendent shall issue a final certificate of
41 authority, subject to annual renewal, when:
42 A. The provider has obtained any required certificate of need or other permits or
43 licenses required prior to construction of the facility;
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1 C. The superintendent is satisfied that the provider has demonstrated that it is
2 financially responsible and shall may reasonably be expected to meet its obligations to
3 subscribers or prospective subscribers;
4 D. The superintendent has determined that the provider's continuing care agreement
5 meets the requirements of section 6206, subsection 3, and the rules promulgated in
6 adopted under this chapter; and
7 G. The provider certifies to the superintendent either:
8 (1) That preliminary continuing care agreements have been entered and deposits
9 of not less than 10% of the entrance fee have been received either:
10 (a) From subscribers with respect to 70% of the residential units, including
11 names and addresses of the subscribers, for which entrance fees will be
12 charged; or
13 (b) From subscribers with respect to 70% of the total entrance fees due or
14 expected at full occupancy of the community; or
15 (2) That preliminary continuing care agreements have been entered and deposits
16 of not less than 25% of the entrance fee received from either:
17 (a) Subscribers with respect to 60% of the residential units, including names
18 and addresses of the subscribers, for which entrance fees will be charged; or
19 (b) Subscribers with respect to 60% of the total entrance fees due or expected
20 at full occupancy of the community.
21 Within 120 days after determining that the application to the superintendent and the
22 department is complete, the superintendent shall issue or deny a final certificate of authority
23 to the provider, unless a certificate of need is required, in which case the final certificate of
24 authority shall be issued or denied in accordance with the certificate of need schedule.
25Sec. 15. 24-A MRSA §6203, sub-§6, as amended by PL 2003, c. 155, §1, is further
26 amended to read:
276. Provision of services to nonresidents. The final certificate of authority must state
28 whether any skilled nursing facility that is part of a life-care community or a continuing
29 care retirement community may provide services to persons who have not been bona fide
30 residents of the community prior to admission to the skilled nursing facility. If the life-
31 care community or the continuing care retirement community admits to its skilled nursing
32 facility only persons who have been bona fide residents of the community prior to
33 admission to the skilled nursing facility, then the community is exempt from the provisions
34 of Title 22, chapter 103‑A, but is subject to the licensing provisions of Title 22, chapter
35 405, and is entitled to only one skilled nursing facility bed for every 4 residential units in
36 the community. Any community exempted under Title 22, chapter 103‑A rules adopted by
37 the department may admit nonresidents of the community to its skilled nursing facility only
38 during the first 3 years of operation. For purposes of this subsection, a "bona fide resident"
39 means a person who has been a resident of the community for a period of not less than 180
40 consecutive days immediately preceding admission to the nursing facility or has been a
41 resident of the community for less than 180 consecutive days but who has been medically
42 admitted to the nursing facility resulting from an illness or accident that occurred
43 subsequent to residence in the community. Any community exempted under Title 22,
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44 chapter 103‑A rules adopted by the department is not entitled to and may not seek any
45 reimbursement or financial assistance under the MaineCare program from any state or
46 federal agency and, as a consequence, that community must continue to provide nursing
47 facility services to any person who has been admitted to the facility.
5 Notwithstanding this subsection, a life-care community that holds a final certificate of
6 authority from the superintendent and that was operational on November 18, 2002 and that
7 is barred from seeking reimbursement or financial assistance under the MaineCare program
8 from a state or federal agency may continue to admit nonresidents of the community to its
9 skilled nursing facility after its first 3 years of operation with the approval of the
10 superintendent. A life-care community that admits nonresidents to its skilled nursing
11 facility as permitted under this subsection may continue to admit nonresidents after its first
12 3 years of operation only for such period as approved by the superintendent after the
13 superintendent's consideration of the financial impact on the life-care community and the
14 impact on the contractual rights of subscribers of the community.
15Sec. 16. 24-A MRSA §6226, as amended by PL 2003, c. 510, Pt. A, §23 is repealed.
16Sec. 17. 24-A MRSA §6951, sub-§6, as enacted by PL 2003, c. 469, Pt. A, §8, is
17 amended to read:
186. Technology assessment. The forum shall conduct technology assessment reviews
19 to guide the use and distribution of new technologies in this State. The forum shall make
20 recommendations to the certificate of need program under Title 22, chapter 103‑A.
21Sec. 18. 35-A MRSA §10122, as enacted by PL 2011, c. 424, Pt. A, §6 and affected
22 by Pt. E, §1, is amended to read:
23§10122. Health care facility program
24 The trust shall develop and implement a process to review projects undertaken by
25 health care facilities that are directed solely at reducing energy costs through energy
26 efficiency, renewable energy technology or smart grid technology and to certify those
27 projects that are likely to be cost-effective. If a project is certified as likely to be cost-
28 effective by the trust, the review process serves as an alternative to the certificate of need
29 process established pursuant to Title 22, section 329, subsection 3.
30Sec. 19. 38 MRSA §1310-X, sub-§4, ¶A, as amended by PL 2003, c. 551, §17, is
31 further amended to read:
32 A. A commercial biomedical waste disposal or treatment facility, if at least 51% of the
33 facility is owned by a licensed hospital or hospitals as defined in Title 22, section 328,
34 subsection 14 or a group of hospitals that are licensed under Title 22 acting through a
35 statewide association of Maine hospitals or a wholly owned affiliate of the association;
36 and
37SUMMARY
38 Under current law, before introducing additional health care services and procedures
39 in a market area, a person must apply for and receive a certificate of need from the
40 Department of Health and Human Services. This bill eliminates that requirement by
41 repealing the Maine Revised Statutes, Title 22, chapter 103-A, which includes sections 326
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42 to 350-C, and making statutory changes to other provisions of law for consistency with the
43 repeal of chapter 103-A.
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